Tag: #UHC

Posted in #unitedhealthcare, Training, Updates

UHC Providers: Genetic testing Penalty waiver has expired!

Posted on by KR2Medical Billing

This blog post applies to genetic/molecular testing penalty waiver, that was available to providers/labs while UHC was transitioning to a new Prior Authorization and notification Platform, in 2021.

This process finished and as of Jan 1,2022 the waiver has expired!

In order to get paid for genetic/molecular testing, providers must request a prior authorization and/or an advanced notification, for any code that requires it.

Where to request prior auth/advanced notification?

Providers must go to  Prior Authorization and Notification platform or by call 877-303-7736.

Performing laboratories can submit advance notifications.

If a test requires prior authorization with clinical criteria, the request must be submitted by the ordering provider.

For the current list of genetic and molecular tests that require prior authorization/advance notification, please go to UHCprovider.com/paan > Advance Notification and Plan Requirement Resources.

Questions?
For more information about the genetic and molecular lab testing prior authorization/advance notification program, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page and review the genetic and molecular lab testing PAAN FAQs.

Prior authorization/advance notification training
UnitedHealthcare is offering live training sessions for the genetic and molecular testing prior authorization/advance notification (PAAN) program. To register for training, please visit the UnitedHealthcare genetic and molecular testing prior authorization/advance notification (PAAN) web page.

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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC Commercial and Exchange Plans: update to Radiology Prior Auth List

Posted on by KR2Medical Billing

As of December 1,2021 the following codes will be added to the radiology prior authorization list. These codes will require an authorization for DOS 12/01/2021 and thereafter.

The prior authorization for these codes WILL NOT APPLY TO The following situations: if the advanced imaging is done in-

  • Emergency room
  • Urgent care center
  • Observation unit
  • Inpatient stay

In case you missed it:

In June 2021, UHC also added more Radiology and Cardiology codes on the Prior Authorization List. These codes apply to UnitedHealthCare Community Plan, Medicare Advantage, commercial and exchange Plans

For complete details on the radiology protocol, refer to the current UnitedHealthcare Administrative Guide

Find this type of information useful? Follow my blog for more insurance payer updates, medical coding and medical billing guideline changes, reimbursement and medical policy updates.

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Posted in #Medicareadvantage, #unitedhealthcare, Training, Updates

UHC: Payment for COVID-19 testing coverage, outpatient SNF

Posted on by KR2Medical Billing

Previously, UHC would not reimburse for COVID-19 testing when done outside of a skilled inpatient stay at a SNF.

However, during the PHE, starting Jan 27,2020 and then renewed on April 21,2021, subject to further extension, UHC is going to pay for the COVID-19 testing that is done outside of the skilled inpatient stay at a SNF.

This change applies to the following Medicare Advantage Plans:

  • Medicare Advantage Plans
  • Dual Eligible Special Needs Plans (DSNP)
  • Chronic Special Needs Plans (CSNP)
  • UnitedHealthcare Assisted Living Plans (IE-SNP)
  • FIDE/MMP Plans

Plans that this change DOES NOT APPLY TO:

  • UnitedHealthcare Nursing Home Plans (ISNP)
  • UnitedHealthcare commercial plans
  • UnitedHealthcare Community Plans (Medicaid Only Plans)

UHC will re-process the claims, there is no further action needed.

UHC will reprocess claims previously paid at $0 to be reimbursed at 100% of the Medicare fee schedule. No action is required from affected SNFs for these adjustments.

The following codes are going be reimbursed at 100% of Medicare Fee Schedule:

Reminder!

COVID-19 testing performed during an approved skilled stay are subject to Centers for Medicare and Medicaid Services (CMS) consolidated billing rules and are not separately reimbursable, except for the UnitedHealthcare Nursing Home Plan (ISNP). New applicable CMS covered COVID-19 testing codes may be added periodically. We may add or remove codes from the following list, in accordance with CMS coverage guidelines.

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